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Itchy Bumps on Neck, Arms or Legs?

That may not be what you think it is. Recognize and treat a common condition that often looks different on dark skin.

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Woman scratching her neck
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Atopic dermatitis, also called eczema, “is characterized by severe itching, redness, oozing, and scaly rashes,” begins one medical organization in its description online. Except — wait a minute — redness isn’t always how it presents for people of color.

 In fact, our melanin can hide redness and inflammation, says Kemunto Mokaya, M.D., a.k.a. Dr. Kemmy, a board-certified dermatologist based in Houston. “Sometimes people just think their skin is dry, but they don’t realize there is an underlying problem,” she says.

 The various conditions of each season can also lead us to not question the cause of a rash we tend to blame on either cold weather or the heat of summer. “For some people, the dry, indoor air of winter causes flare-ups. But for others, it’s warmer weather — and the sweating, outdoor allergens and increased exposure to sunlight — that can ignite a bout of itching, rashes and other symptoms,” says the American Academy of Dermatology Association.

Heat Rash Versus Eczema

Eczema symptoms resemble heat rash, but they need to be managed differently. Heat rash bumps tend to clear quickly, helped along by a cool shower and some calamine lotion or mild hydrocortisone cream. Eczema is chronic and may need expert care. One tip-off is that heat rash tends to appear where there are folds or friction. Eczema can show up in many places (see symptoms, below).

For some people, the dry, indoor air of winter causes flare-ups. But for others, it’s warmer weather — and the sweating, outdoor allergens and increased exposure to sunlight — that can ignite a bout of itching, rashes and other symptoms.
American Academy of Dermatology Association

If you’ve been dealing with itchy, dry, scaly or discolored skin, it’s a good idea to consult a health care provider who understands Black skin. Eczema is one of the most frequently occurring skin diseases in African Americans, the Skin of Color Society reports. And people with this noncontagious condition can deal with sleep issues, embarrassment in social situations and more, the National Eczema Association notes.

Even celebs like Kerry Washington and Tia Mowry have dealt with it. But while eczema isn’t curable, it is treatable. And you can help prevent periods of heightened symptoms (also called “flares”).

What to know about symptoms

While the exact cause is unknown, for most types of eczema, researchers believe a combination of genes and triggers are involved, the National Eczema Association reports, adding that people who have it “tend to have an overreactive immune system” that “when triggered by a substance outside or inside the body, responds by producing inflammation.”

Plus, African Americans who have atopic dermatitis have more inflammation than European Americans with the condition, according to research from the Icahn School of Medicine at Mount Sinai.

Symptoms can include dryness, itchiness (which can be severe) and that discoloration we mentioned above. Symptoms also may include those that follow.

  • Patches that can range in color from red to brownish-gray, especially on the hands, feet, ankles, wrists, neck, upper chest, eyelids and where the skin bends, like the elbows and knees; and in infants, most often on the face
  • Small and raised bumps, which can be unique to brown and Black skin
  • Bumps around hair follicles
  • Thickened, cracked and scaly skin
  • Raw, sensitive or swollen skin from scratching

You also may see dark circles under your eyes, particularly if you have facial eczema and rub the area, Dr. Mokaya says. And severe cases of eczema can bring large areas of thickened skin, with picking or scratching over time potentially resulting in hard nodules, she adds.

Complications can include sores and cracks that increase the risk of infection, as well as poor sleep quality due to itching. To help track your symptoms, you may want to keep a diary. And consider taking photos of your skin when it’s normal and when it flares, Dr. Mokaya says, and sharing with your provider.

What to know about treatment

Bring on the relief, right? Treatments include over-the-counter remedies and pain relievers to help with sleep; medicated shampoos for eczema of the scalp (also called seborrheic dermatitis); and topical hydrocortisone, available over the counter to temporarily relieve itching and rashes.

Other items include prescriptions applied to the skin, including steroids as well as medications called calcineurin inhibitors and PDE4 inhibitors. Injectable and oral prescription medications also are available, and light therapy may be an option for widespread eczema or eczema that doesn’t respond to topicals, the National Eczema Association notes.

Treatment depends on the severity of your condition, Dr. Mokaya explains, adding two cautions. For one, tell your provider if you’re interested in treatments acquired outside of the United States or in nontraditional medicines. Though your bestie may swear by a cream from the Caribbean, medicines sold in other countries can contain steroids, Dr. Mokaya explains. And it’s possible to unintentionally double up on ingredients.

Also use items as directed. If overused, stronger steroids can lead to pigment loss, Dr. Mokaya notes. So share any questions with your provider.

What to do for prevention

Before we wrap up, consider these tips to prevent flares.

Adjust your bathing habits. You may adore long, hot showers. But if you have eczema, keep showers lukewarm and under 10 minutes, Dr. Mokaya says. (If hot showers were your form of self-care — we get it — consider a different activity or experience.)

Avoid products with fragrance or strong detergents. These personal and laundry products can be irritating. Also avoid antibacterial and deodorant soaps, as they can irritate skin. (By the way, mild and fragrance-free products can be ideal for other reasons, including for “down there” care.)

Dry yourself carefully and moisturize. After washing, dry your skin with a soft towel and put on fragrance-free moisturizer while your skin is damp. And since eczema can cause your skin to darken in spots, keep wearing sunscreen.

Focus on fabric and fit. Try 100 percent cotton or silk. And consider looser layers to avoid overheating. For exercise, consider performance fabrics with antimicrobial and moisture-wicking properties.

Watch out for triggers. Sweat, pollen or dust can be triggers, along with anxiety and stress. And you may have flares in winter, when your skin is dry, or in summer, when it’s hot and you’re sweating more. (In winter, Dr. Mokaya says you may consider using a humidifier for prevention.) Eczema also may be triggered by certain foods based on individual allergies and sensitivities, so do consider tracking any symptoms and discussing with your provider if needed.

And, Sis, remember this: You don’t have to be embarrassed by your skin or suffer without help. Once you know what you’re dealing with, it can be managed.

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